| NPI | 1568520245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C009803) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 149-006656) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2019-06-18 |