| NPI | 1225466568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149015940) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW14038) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2021-04-20 |