| NPI | 1649462615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 60034547) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00000303) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2011-06-20 |