| NPI | 1598562456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149028563) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926196) |
| Enumeration Date | 2025-02-27 |
| Last Update Date | 2025-02-27 |