Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003362849 |
---|---|
Provider Name | Mr. Randy Joshua Williamson |
First Address | Oklahoma City, OK 73114-7609 |
Second Address | Oklahoma City, OK 73114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 31/08/2016 |