Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | D7960040 | CA |
NPI | 1003397597 |
---|---|
Provider Name | Joshua Thomas Duitsman |
First Address | Rocklin, CA 95765-4437 |
Second Address | Rocklin, CA 95765-4437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D7960040 | (05) | CA |