| NPI | 1538379912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904006028) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-003009) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2011-04-20 |