| NPI | 1134465263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AL 4127C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.014379) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2018-10-21 |