Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1578931770 |
---|---|
Provider Name | Aaron Gonzalez |
First Address | Kissimmee, FL 34759-4447 |
Second Address | Kissimmee, FL 34759-4447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2015 |
Last Update Date | 04/09/2015 |