| NPI | 1134741283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI 6801063118) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 149006760) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2020-05-12 |