| NPI | 1215340773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: WV BP00947033) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225700000X Massage Therapist (Licence: WV 2012-2932) | |
| 225700000X Massage Therapist (Licence: MD M04990) | |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2025-04-01 |