| NPI | 1164295812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-22969) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AZ LMT-25730) |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2025-01-20 |