| NPI | 1528716107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.024958) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.104351) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2022-10-18 |