| NPI | 1134596489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.020246) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: CA 81840) | |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926603) | |
| Enumeration Date | 2015-08-21 |
| Last Update Date | 2020-08-21 |