| NPI | 1992283428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 56447) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 150015775) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2020-03-23 |