| NPI | 1427128859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081412-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-010219) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2015-10-25 |