| NPI | 1083140743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: FL 86040) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 29012) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2026-03-30 |