| NPI | 1952604589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2017016025) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: IL 149018027) | |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2021-03-16 |