| NPI | 1801074422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-3489) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.011474) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2009-10-27 |