| NPI | 1548632730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.022590) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 117562) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2026-01-20 |