| NPI | 1225450125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC006521) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: PA MSG003108) |
| Enumeration Date | 2014-01-11 |
| Last Update Date | 2014-01-11 |