| NPI | 1194014670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.014649) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149014649) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2019-12-03 |