| NPI | 1740672682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.019286) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.015496) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2022-10-07 |