| NPI | 1598519878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 374K00000X Religious Nonmedical Practitioner |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-09-21 |