| NPI | 1194034769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L12108) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.015804) |
| 1041C0700X Social Worker, Clinical (Licence: MD 19539) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2025-04-08 |