| NPI | 1154746840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149019501) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 09508601) |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2024-04-22 |