| NPI | 1174302285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: IL 2600972) |
| 104100000X Social Worker (Licence: MO 20220002656) | |
| Enumeration Date | 2023-09-27 |
| Last Update Date | 2024-08-23 |