| NPI | 1124385604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149012560) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 076536-1) |
| 1041C0700X Social Worker, Clinical (Licence: CA 65721) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2018-07-24 |