Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-11-8681 | CA |
NPI | 1013265123 |
---|---|
Provider Name | Mr. Adam Daitch Bulbulia |
First Address | Ukiah, CA 95482-5305 |
Second Address | Ukiah, CA 95482-5305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2012 |
Last Update Date | 21/08/2012 |