| 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 |