| NPI | 1407517980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 123144) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149020910) |
| Enumeration Date | 2022-01-06 |
| Last Update Date | 2022-01-06 |