| NPI | 1750614053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149008608) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW00009593) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2018-05-14 |