| NPI | 1609315662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-003693) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM C-10292) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2018-06-16 |