| NPI | 1700653078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: DC LC200002982) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149023968) |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2023-12-07 |