Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1104348986 |
---|---|
Provider Name | Mahtob Khalil |
First Address | Newton, MA 02464-1492 |
Second Address | Needham, MA 02494-2027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2017 |
Last Update Date | 12/07/2017 |