| NPI | 1104300664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149020604) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.020604) |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2021-06-23 |