| NPI | 1265825202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.024766) |
| Additional Taxonomies | 385H00000X Respite Care |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2022-09-06 |