Individual
MR. ANTONIO LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2025 E AZTEC AVE, GALLUP, NM 87301-4803
(505) 863-3828
Mailing address
2025 E AZTEC AVE, GALLUP, NM 87301-4803
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
05/28/2010
Last updated
05/28/2010
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