| NPI | 1063142842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149028424) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150107269) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2026-01-27 |