| NPI | 1427198241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-003801) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 0355) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2008-05-05 |