| NPI | 1295906089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH0001106) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA0004919) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2008-04-25 |