| NPI | 1609291517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225700000X Massage Therapist (Licence: CA 33714) | |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2021-02-17 |