| NPI | 1770984932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IL 149020416) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 67274) |
| 104100000X Social Worker (Licence: NY 101058) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 1770984932) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149020416) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2018-08-31 |