| NPI | 1225356132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH1644) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA3474) |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2010-05-17 |