| NPI | 1245951086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 61347503) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA61630639) |
| Enumeration Date | 2022-09-09 |
| Last Update Date | 2024-12-16 |