| NPI | 1659679983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149015583) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34006574A) |
| Enumeration Date | 2011-03-10 |
| Last Update Date | 2013-09-16 |