Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1366012148 |
---|---|
Provider Name | Mr. Zachary Ryan Kuster |
First Address | Panama City, FL 32404-9316 |
Second Address | Panama City, FL 32405-4737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2021 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
713801322 | HPSO (01) | FL |