Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-43212 | TX |
NPI | 1003421504 |
---|---|
Provider Name | Payal Dhruv Patel |
First Address | Austin, TX 78723-6144 |
Second Address | Austin, TX 78748-6556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |