| NPI | 1528433786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149019055) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150015284) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2017-04-05 |