| NPI | 1396178646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.018710) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150015189) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2016-11-08 |