| NPI | 1588912679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 122593) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 1490.18332) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2024-05-03 |