| NPI | 1962946111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 251SOOOOOX) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.017150) |
| 1041C0700X Social Worker, Clinical (Licence: IL 46-5304932) | |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2016-12-07 |