| NPI | 1538476742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149014264) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2009028441) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2010-09-09 |