| NPI | 1366893026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AK 101391) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2021-08-30 |