| NPI | 1114659927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: VT 097.0135085) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 225700000X Massage Therapist (Licence: CO MT.0024401) | |
| 225700000X Massage Therapist (Licence: VT 164.0000760) | |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2022-11-07 |