| NPI | 1386754109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 002120) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.002556) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-03-21 |