| NPI | 1205553021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.027266) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 150.108804) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2025-03-26 |