| NPI | 1033455050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 008161) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149008166) |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2012-12-19 |