| NPI | 1699118323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61583852) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00024056) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2024-10-30 |