| NPI | 1659762110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401009538) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0013306) |
| 225700000X Massage Therapist (Licence: MI 7501005113) | |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2021-02-02 |