| NPI | 1679559959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149010770) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180005345) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2024-01-29 |