| NPI | 1154641181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.014556) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 19232) |
| 1041C0700X Social Worker, Clinical (Licence: MD 21495) | |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2022-11-01 |