| NPI | 1245699776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.018928) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.015253) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2016-11-01 |