| NPI | 1245085596 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CG61618266) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA92972) |
| Enumeration Date | 2024-04-20 |
| Last Update Date | 2024-10-02 |