| NPI | 1902612070 |
|---|---|
| Former Name | IDELFONSO ENRIQUEZ CARVAJAL |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WY PPC-1551) |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2025-06-19 |