| NPI | 1568635613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.023430) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 84870) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2023-07-14 |