| NPI | 1649757576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.021001) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.102194) |
| 1041C0700X Social Worker, Clinical (Licence: MA 1121131) | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2025-09-03 |