| NPI | 1851171524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 110753) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IA 118878) |
| Enumeration Date | 2023-10-02 |
| Last Update Date | 2024-01-10 |