| NPI | 1578161725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149029724) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801102158) |
| Enumeration Date | 2020-10-10 |
| Last Update Date | 2025-09-29 |