| NPI | 1154754463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2012018729) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.015165) |
| Enumeration Date | 2013-08-11 |
| Last Update Date | 2014-04-15 |