| NPI | 1023046091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149009654) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2003017029) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2010-08-20 |