Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013299171 |
---|---|
Provider Name | Jovan H Andrade |
First Address | Frederick, MD 21701-3709 |
Second Address | Frederick, MD 21701-3709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2011 |
Last Update Date | 09/01/2016 |