| NPI | 1710072244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-003694) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW022358) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2024-12-31 |