| NPI | 1841365798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 000746) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 1499.007334) |
| 1041C0700X Social Worker, Clinical (Licence: FL 0005083) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-07-08 |