| NPI | 1225330277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.019644) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 4135) |
| 1041C0700X Social Worker, Clinical (Licence: TX 56085) | |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2018-03-17 |