| NPI | 1043602097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.019361) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150015340) |
| Enumeration Date | 2015-02-28 |
| Last Update Date | 2020-02-24 |