| NPI | 1245493600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8745) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WI 980) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2021-04-05 |