| NPI | 1497764781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 18136) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 10882) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |