| NPI | 1174516991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 00529) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149006072) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2013-04-22 |