| NPI | 1265774640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3076) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 10179) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2015-12-09 |