Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-17-25244 | TX |
NPI | 1003348244 |
---|---|
Provider Name | Sophia Kassim |
First Address | Austin, TX 78705-3377 |
Second Address | Austin, TX 78705-3377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 29/03/2017 |