Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | CA | |
N | 106E00000X | Assistant Behavior Analyst | CA |
NPI | 1144790247 |
---|---|
Provider Name | Johnathan Hanlin |
First Address | San Jose, CA 95120-1938 |
Second Address | Alameda, CA 94501-1188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2018 |
Last Update Date | 30/11/2018 |