| NPI | 1689274763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.023548) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: WI 12567-123) | |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2026-04-03 |