| NPI | 1578370920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: IL 150.113922) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 150.113922) |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2024-12-18 |