NPI | 1366710428 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 256945) |
Additional Taxonomies | 225700000X Massage Therapist (Licence: KY 3725) |
Enumeration Date | 2011-12-05 |
Last Update Date | 2024-01-04 |