| NPI | 1669939153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.022971) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: NY 094867) | |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2023-10-17 |