| NPI | 1053112201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 171400000X | |
| 175T00000X Peer Specialist | |
| 372500000X Chore Provider | |
| 372600000X Adult Companion | |
| 374K00000X Religious Nonmedical Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-03-24 |