| NPI | 1790390615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225700000X Massage Therapist (Licence: CA NA) | |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2025-09-29 |