| NPI | 1487123493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.015005) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149015005) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2024-07-09 |