| NPI | 1427336361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R8714) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 13376) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2024-11-08 |