| NPI | 1578358214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 374K00000X Religious Nonmedical Practitioner (Licence: OK ULC600728) |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-12-18 |