| NPI | 1356980486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149021831) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 133254) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2025-10-14 |