| NPI | 1740348861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 5647) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.011326) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2025-05-13 |