| NPI | 1588071286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2013044527) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149003365) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2014-07-15 |