Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH 8050 | FL |
NPI | 1003109117 |
---|---|
Provider Name | Edison Aguirre |
First Address | Miramar, FL 33025-6605 |
Second Address | Miramar, FL 33025-6605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2011 |
Last Update Date | 23/05/2011 |