| NPI | 1639443138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149021755) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 104100000X Social Worker (Licence: IL 150101823) | |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2019-11-20 |