| NPI | 1366710428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 259763) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: KY 3725) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2024-10-22 |