| NPI | 1134684095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.021740) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150102381) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2025-05-15 |