| NPI | 1457502635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149013735) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150011269) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2018-05-31 |