| NPI | 1114550068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149024937) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 14271474-3501) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2026-06-21 |