| NPI | 1104970581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149010583) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801117776) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2024-04-22 |