Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003176132 |
---|---|
Provider Name | Mr. Jayson Lobley |
First Address | Melbourne, FL 32901-4901 |
Second Address | Melbourne, FL 32901-4901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2012 |
Last Update Date | 23/05/2012 |