Individual
BRANDON WILSON PROUTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
806 N WEST ST, CHEWELAH, WA 99109-9188
(808) 681-2718
Mailing address
944 LAWELAWE ST, HONOLULU, HI 96821-1770
(808) 681-2718
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
23-261073
WA
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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