Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 7170549-6009 | UT |
NPI | 1003132028 |
---|---|
Provider Name | Mr. Siope Lee Kinikini |
First Address | West Valley City, UT 84128 |
Second Address | Salt Lake City, UT 84121-1359 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2010 |
Last Update Date | 17/09/2010 |