| NPI | 1427129949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-000145) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 148.000145) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2021-02-11 |