Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1003467689 |
---|---|
Provider Name | Johnny Davis |
First Address | Cleveland, OH 44108-1446 |
Second Address | Berea, OH 44017-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2019 |
Last Update Date | 24/09/2019 |