| NPI | 1477757474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L5127) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 13466) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2021-05-19 |