| NPI | 1730623562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149019833) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150014733) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2019-03-30 |