Individual
BRADEN FAVERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2563 W 5800 S, ROY, UT 84067-1334
(801) 991-0579
Mailing address
2563 W 5800 S, ROY, UT 84067-1334
(801) 991-0579
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB346416
UT
Other
Enumeration date
05/11/2017
Last updated
05/11/2017
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