| NPI | 1073104741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-20771) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149022902) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2023-08-09 |