| NPI | 1376892299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374K00000X Religious Nonmedical Practitioner |
| Additional Taxonomies | 374K00000X Religious Nonmedical Practitioner |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2012-09-06 |