| NPI | 1275912107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2017009044) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149017465) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2018-06-22 |