Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003388521 |
---|---|
Provider Name | Jonathan L Miceli |
First Address | Novi, MI 48375-1803 |
Second Address | Novi, MI 48375-1803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2018 |
Last Update Date | 21/12/2018 |