| NPI | 1376967570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 27099) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.016078) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2018-04-23 |