Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1134707474 |
---|---|
Provider Name | Mr. Ajamu Frasier |
First Address | Northridge, CA 91324-3811 |
Second Address | Northridge, CA 91324-3811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2021 |
Last Update Date | 30/03/2021 |