| NPI | 1003211350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4044) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60418527) |
| 101YM0800X Counselor, Mental Health (Licence: OR C4044) | |
| 225700000X Massage Therapist (Licence: WA MA60177340) | |
| 225700000X Massage Therapist (Licence: OR LMT22244) | |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2023-05-25 |