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 |