Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003210071 |
---|---|
Provider Name | Joseph Kohm |
First Address | Brodheadsville, PA 18322 |
Second Address | Brodheadsville, PA 18322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2014 |
Last Update Date | 20/10/2014 |