| NPI | 1265470496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149019280) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34004801A) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-07-21 |