| NPI | 1659509073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 082347-1) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: IL 149014090) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2014-12-12 |