Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003264409 |
---|---|
Provider Name | Boris Amores |
First Address | Lehigh Acres, FL 33973-6615 |
Second Address | Lehigh Acres, FL 33973-6615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2016 |
Last Update Date | 26/05/2016 |