| NPI | 1689750770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2000174414) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-009820) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2007-07-08 |