| NPI | 1194195032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2004844) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 022335) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2020-05-28 |