| NPI | 1396623906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 150.114544) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.041142) |
| Enumeration Date | 2025-08-22 |
| Last Update Date | 2026-05-12 |