| NPI | 1386758183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 1566) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149010898) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2012-03-05 |