| NPI | 1649387168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7116-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 150007591) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-04-25 |