| NPI | 1841343662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 000331) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MO 2004003080) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2009-09-09 |