| NPI | 1215520044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.025480) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 226601) |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2023-04-24 |