| NPI | 1326466061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.016344) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801092895) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2014-03-31 |