| NPI | 1598283756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 374K00000X Religious Nonmedical Practitioner | |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2022-07-21 |