| NPI | 1376257923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 129330) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CA 73723) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-01-09 |