| NPI | 1679906382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008320) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VA 0121001241) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2026-01-10 |