| NPI | 1194825844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW15604) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-008343) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2022-09-09 |