| NPI | 1225668270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 177F00000X Lodging |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP1600X Counselor Pastoral | |
| 175T00000X Peer Specialist | |
| 176P00000X Funeral Director | |
| 177F00000X Lodging | |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2020-01-17 |