| NPI | 1275244741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149.028221) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.109801) |
| Enumeration Date | 2022-12-06 |
| Last Update Date | 2025-07-11 |