| NPI | 1073077335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149011615) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: IL 1914594) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2021-08-18 |