| NPI | 1063422665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2002027247) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 149.011431) |
| 1041C0700X Social Worker Clinical (Licence: IL 149-011431) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2020-04-28 |