Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1033407168 |
---|---|
Provider Name | Mr. Brian J. Kern |
First Address | New Tripoli, PA 18066-3649 |
Second Address | New Tripoli, PA 18066-3649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 11/07/2011 |