| NPI | 1104569169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.030629) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 090397) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2025-12-08 |