| NPI | 1164956272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904011145) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149018845) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2024-06-25 |