| NPI | 1992010193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 66343) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150012634) |
| 1041C0700X Social Worker, Clinical (Licence: SC 11031) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149015330) | |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2018-09-17 |