| NPI | 1013377803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.028470) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801098361) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2025-08-25 |