| NPI | 1023787512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122639) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149025647) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2023042348) | |
| Enumeration Date | 2021-09-08 |
| Last Update Date | 2026-04-15 |