| NPI | 1417276031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WI 8441-123) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 149.011832) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2016-02-22 |