| NPI | 1225640139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149.028113) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.107001) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2024-11-07 |