| NPI | 1215440532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149005238) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 149005238) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2022-02-15 |