| NPI | 1518794981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 150.129076) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851121953) |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2026-09-18 |