| NPI | 1659980472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL mh20830) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA81560) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2022-11-08 |