| NPI | 1134596513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.029728) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.115979) |
| 101Y00000X Counselor | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2025-07-24 |