| NPI | 1386643278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW12114) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149006018) |
| 1041C0700X Social Worker, Clinical (Licence: MS MS-C7552) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2024-03-27 |