Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003339029 |
---|---|
Provider Name | Mr. Wilfredo Torres JR. |
First Address | Riverhead, NY 11901-3936 |
Second Address | Bellmore, NY 11710-5784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2017 |
Last Update Date | 21/07/2017 |