| NPI | 1245499151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149.013059) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: IL 2239902) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-07-21 |