Individual
IAN ROTH MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
121 SW SALMON ST FL 11, PORTLAND, OR 97204-2908
(855) 832-6727
Mailing address
7108 S KANNER HWY, STUART, FL 34997-7462
(855) 832-6727
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/12/2021
Last updated
12/12/2021
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