Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013247592 |
---|---|
Provider Name | Paul Smith |
First Address | Tucson, AZ 85719-5250 |
Second Address | Tucson, AZ 85719-5250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2010 |
Last Update Date | 06/01/2010 |