Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1275190761 |
---|---|
Provider Name | Benjamin Wegner |
First Address | Culver City, CA 90230-4820 |
Second Address | Culver City, CA 90230-4820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/09/2020 |