Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003162363 |
---|---|
Provider Name | Gendry Montesino |
First Address | Hialeah, FL 33018-2005 |
Second Address | Hialeah, FL 33018-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2012 |
Last Update Date | 25/02/2019 |