Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003340357 |
---|---|
Provider Name | Michael Obirek |
First Address | Lake Mary, FL 32746-3625 |
Second Address | Daytona Beach, FL 32114-5747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2017 |
Last Update Date | 13/04/2017 |