| NPI | 1477017713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IL 149020844) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.020844) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2025-08-01 |