Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003155268 |
---|---|
Provider Name | David Young |
First Address | Albuquerque, NM 87120-1213 |
Second Address | Los Lunas, NM 87031-5242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2013 |
Last Update Date | 26/06/2015 |