| NPI | 1477675908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 05172) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MD U272) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2008-03-06 |