| NPI | 1285191312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 82956) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 149.020877) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2022-01-09 |