| NPI | 1912607532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 29891) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 16841) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-03-03 |