Individual
BRANDON BOUTVYSETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5561 E KINGS CANYON RD, FRESNO, CA 93727-4528
(559) 255-0496
Mailing address
2307 S HOMSY AVE, FRESNO, CA 93727-5276
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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