| NPI | 1194231019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.019633) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 008410) |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2018-03-17 |