| NPI | 1891137683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 16951) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.012693) |
| 1041C0700X Social Worker, Clinical (Licence: IN 34006775A) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149.015862) | |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2023-04-18 |