| NPI | 1124491980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34007795A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.017822) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2023-06-21 |