| NPI | 1457425274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149000720) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 680184888) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |