| NPI | 1194874511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7452) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.011635) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-10-15 |