| NPI | 1679793913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.002241) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 149002241) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2019-12-26 |