Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1003101320 |
---|---|
Provider Name | Jose N Gomez |
First Address | Aventura, FL 33160-4802 |
Second Address | Aventura, FL 33160-4802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2011 |
Last Update Date | 15/06/2011 |