| NPI | 1235697954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.023568) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1140960) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904017718) | |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2026-02-24 |