Individual
ETHAN NICOLAUS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1114 3RD ST NW, SALEM, OR 97304-4063
(707) 849-0253
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/30/2024
Last updated
10/30/2024
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