| NPI | 1285711333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180002283) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 180002283) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2024-01-24 |