| NPI | 1417143207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 84945) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-003769) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2019-12-19 |