Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003306440 |
---|---|
Provider Name | Sitara Ethiraj |
First Address | San Jose, CA 95126-1629 |
Second Address | San Jose, CA 95126-1629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 29/09/2021 |