| NPI | 1053083899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.026110) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.105130) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2024-06-05 |