| NPI | 1427657782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149026083) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.104673) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2024-10-18 |