| NPI | 1225192289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149002301) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34004786A) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2007-07-08 |