| NPI | 1982715751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7695-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149-008000) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-09-30 |