| NPI | 1164656344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7355-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149012107) |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2011-07-05 |