Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-14-16838 | PA |
NPI | 1003206566 |
---|---|
Provider Name | Mr. Nicholas Santillano |
First Address | White Salmon, WA 98672-0160 |
Second Address | White Salmon, WA 98672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2015 |
Last Update Date | 23/07/2018 |