| NPI | 1659648863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.016312) |
| Additional Taxonomies | 104100000X Social Worker (Licence: LA 10527) |
| Enumeration Date | 2011-11-17 |
| Last Update Date | 2016-09-10 |