Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1104148659 |
---|---|
Provider Name | Mr. Ronald Fraser |
First Address | Lanoka Harbor, NJ 08734-2103 |
Second Address | Lanoka Harbor, NJ 08734-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2010 |
Last Update Date | 25/02/2010 |