| NPI | 1902076037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 62698) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.012683) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2018-10-16 |