| NPI | 1841337730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-005562) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 4718) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2019-04-01 |