Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 106S00000X | Behavior Technician | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1033653498 |
---|---|
Provider Name | Kenon Simon |
First Address | Las Vegas, NV 89115-6409 |
Second Address | Las Vegas, NV 89115-6409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 06/12/2016 |