| NPI | 1255009882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.018180) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2016002322) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2024-12-09 |