| NPI | 1205571171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149025090) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 149025090) |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2023-01-30 |