Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003187337 |
---|---|
Provider Name | Ernest Wayne Brown |
First Address | Santa Fe, NM 87592-8220 |
Second Address | Raton, NM 87740-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 18/01/2012 |