| NPI | 1487104873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149027747) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2025049414) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2025-11-18 |