| NPI | 1144889650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2019040488) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.021964) |
| Enumeration Date | 2019-06-08 |
| Last Update Date | 2025-09-12 |