Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1053898650 |
---|---|
Provider Name | Leslie Marie Manso |
First Address | Davie, FL 33328-1915 |
Second Address | Davie, FL 33328-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2018 |
Last Update Date | 26/07/2018 |