| NPI | 1003162983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 8447123) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 149017843) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2017-04-01 |