Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003366089 |
---|---|
Provider Name | Lukas Hildebrandt |
First Address | Taylorsville, UT 84123-5220 |
Second Address | St George, UT 84770-3187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2016 |
Last Update Date | 13/10/2016 |