| NPI | 1013490432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090513) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.020525) |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2021-04-08 |