Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | IN |
NPI | 1063923456 |
---|---|
Provider Name | Gabriel P Koser |
First Address | North Webster, IN 46555 |
Second Address | North Webster, IN 46555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2017 |
Last Update Date | 12/10/2017 |