| NPI | 1518049618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-000270) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.0500079) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2010-08-19 |