| NPI | 1386023794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149020655) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C013537) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 104100000X Social Worker | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2025-12-10 |