| NPI | 1952598294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| 174H00000X Health Educator | |
| 173C00000X Reflexologist | |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2013-06-14 |