| NPI | 1407117799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.014797) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.008090) |
| Enumeration Date | 2012-06-03 |
| Last Update Date | 2021-07-09 |