| NPI | 1437657376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPCC.0015846) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: CO MT.0020930) |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2018-06-20 |