| NPI | 1376817510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34006533A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149007563) |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2024-02-12 |