Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003396656 |
---|---|
Provider Name | Nathanial Cornell |
First Address | El Dorado Hills, CA 95762-9360 |
Second Address | El Dorado Hills, CA 95762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 15/08/2018 |