Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1114446507 |
---|---|
Provider Name | Roberto Carlos Moran |
First Address | Sanford, FL 32773-6894 |
Second Address | Sanford, FL 32773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2017 |
Last Update Date | 17/03/2018 |