| NPI | 1821176744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 007162) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149009107) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-04-01 |