| NPI | 1184482473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IL 150.129116) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2026-04-14 |