| NPI | 1982765772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: TN 000-1216) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: FL MA47923) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-07-02 |