Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | FL |
NPI | 1003393745 |
---|---|
Provider Name | Paul Leslie Gaspar |
First Address | Bonita Springs, FL 34135-8082 |
Second Address | Bonita Springs, FL 34135-8082 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2018 |
Last Update Date | 25/07/2018 |