Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1164174777 |
---|---|
Provider Name | Dr. Momo Sando Larmena JR. |
First Address | Cape Coral, FL 33909-5422 |
Second Address | Cape Coral, FL 33909-5422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2022 |
Last Update Date | 25/01/2022 |