NPI | 1467525709 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149011394) |
Additional Taxonomies | 101Y00000X Counselor (Licence: IL 149011394) |
Enumeration Date | 2006-11-16 |
Last Update Date | 2020-12-20 |