| NPI | 1548777840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.021352) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.101965) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2022-07-10 |