Individual
EVAN GREGOIRE MUTOMBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
1129 NORTHERN BLVD STE 404, MANHASSET, NY 11030-3022
(718) 395-4522
Mailing address
1583 MARSHALL ST, ELMONT, NY 11003-1335
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-194041
—
Other
Enumeration date
12/23/2021
Last updated
12/23/2021
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