Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003325747 |
---|---|
Provider Name | Marcian Evans |
First Address | Sacramento, CA 95823-5922 |
Second Address | Sacramento, CA 95816-3326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2017 |
Last Update Date | 26/09/2017 |