Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003373762 |
---|---|
Provider Name | Nicholas Anthony Linville |
First Address | Fresno, CA 93722-3446 |
Second Address | Clovis, CA 93612-0311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2019 |
Last Update Date | 28/02/2019 |