| NPI | 1255739504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.015592) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.009378) |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2014-12-18 |