Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003351537 |
---|---|
Provider Name | Joshua Maikoski |
First Address | Portage, MI 49002-3049 |
Second Address | Portage, MI 49002-3049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2016 |
Last Update Date | 19/12/2016 |