| NPI | 1356475842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149003151) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 6891123) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2008-01-16 |