Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003357435 |
---|---|
Provider Name | Marlon Fray |
First Address | Miami, FL 33181-3151 |
Second Address | Miami, FL 33181-3151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2017 |
Last Update Date | 18/03/2017 |