Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003314436 |
---|---|
Provider Name | Maurhy Alfredo Meneses |
First Address | Bountiful, UT 84010-7043 |
Second Address | Provo, UT 84604-3049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2018 |
Last Update Date | 31/01/2018 |