| NPI | 1215230818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-007201) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149007201) |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2013-10-01 |