Individual
IVAN LUQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9424 41ST AVE, ELMHURST, NY 11373-1722
(201) 887-0652
Mailing address
9424 41ST AVE, ELMHURST, NY 11373-1722
(201) 887-0652
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/09/2014
Last updated
02/09/2014
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