Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | FL |
NPI | 1003409582 |
---|---|
Provider Name | Ronni Justin Irving |
First Address | Deerfield Beach, FL 33441-1817 |
Second Address | Deerfield Beach, FL 33441-1817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2021 |
Last Update Date | 16/02/2021 |