| NPI | 1851378814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.024548) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 33383) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2023-01-04 |