| NPI | 1609818715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149008194) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-19024) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2023-07-07 |