Individual
JAYSON EGWUONWU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12553 W EXPLORER DR STE 190, BOISE, ID 83713-1612
(208) 972-5254
Mailing address
12553 W EXPLORER DR STE 190, BOISE, ID 83713-1612
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/01/2020
Last updated
03/01/2020
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