| NPI | 1679657399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ LCSW18553) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IL 149009297) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-11-03 |