| NPI | 1710139274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 008172) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 027228) |
| 251S00000X | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2019-09-09 |