| NPI | 1689255085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.028226) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2020040008) |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2025-01-13 |