| NPI | 1720005440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34001917A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-001105) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-12-10 |