| NPI | 1245566983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149014963) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 10790) |
| 104100000X Social Worker (Licence: IL 150012593) | |
| Enumeration Date | 2009-10-31 |
| Last Update Date | 2016-10-25 |