| NPI | 1083186282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A20708) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NC 17381) |
| Enumeration Date | 2018-12-28 |
| Last Update Date | 2026-02-11 |