| NPI | 1710278528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 116408) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.014588) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2025-04-04 |