| NPI | 1477589802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149012871) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 1175) |
| 106H00000X Marriage & Family Therapist (Licence: WI 17) | |
| 106H00000X Marriage & Family Therapist (Licence: IL 166000732) | |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2009-02-03 |