Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1023501186 |
---|---|
Provider Name | Nicklaus Jon Duiker |
First Address | Detroit, MI 48243-1502 |
Second Address | Detroit, MI 48243-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2018 |
Last Update Date | 12/06/2018 |