| NPI | 1326764036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149025904) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 116073) |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2025-06-03 |