Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003317009 |
---|---|
Provider Name | Mr. Michael James Thompson |
First Address | Cameron Park, CA 95682-7907 |
Second Address | Carmichael, CA 95608-1128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2018 |
Last Update Date | 24/02/2018 |