Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1124794862 |
---|---|
Provider Name | Paul Mertens |
First Address | San Andreas, CA 95249-1144 |
Second Address | San Andreas, CA 95249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2021 |
Last Update Date | 13/09/2021 |