Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 02234 | MN |
NPI | 1003450198 |
---|---|
Provider Name | Pang Xiong |
First Address | Saint Paul, MN 55104-4636 |
Second Address | Saint Paul, MN 55104-4636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2019 |
Last Update Date | 31/10/2019 |