NPI | 1003343096 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149023741) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2017-05-22 |
Last Update Date | 2022-04-12 |