| NPI | 1811236318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 79423) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.015130) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2024-05-15 |