| NPI | 1790941300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149012706) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2007033648) |
| Enumeration Date | 2008-08-03 |
| Last Update Date | 2016-10-21 |