| NPI | 1275937203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.017004) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 9454-123) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2022-08-08 |