| NPI | 1215445945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.020684) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.101899) |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2025-05-22 |