| NPI | 1114562402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 101214) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.024741) |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2022-09-01 |