Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003264698 |
---|---|
Provider Name | Kristofer Sadeck |
First Address | Marion, MA 02738-1006 |
Second Address | Plymouth, MA 02360-4881 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2016 |
Last Update Date | 25/05/2016 |