| NPI | 1316315138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.026740) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 131268) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2026-08-17 |