| NPI | 1720629629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149021326) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904012075) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2023-07-26 |