| NPI | 1528178514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.024314) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW11822) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-09-23 |