| NPI | 1083011167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149018460) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.015269) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2024-02-08 |