| NPI | 1679689699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 5478) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NCTMB 308956-00) |
| 225700000X Massage Therapist (Licence: FL MA34970) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 110348) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C003436) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2024-01-23 |