| NPI | 1780620260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 2471C3402X Radiologic Technologist, Radiography (Licence: FL 43080) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-02-03 |