| NPI | 1760252779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.026007) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI LL6851111134) |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-08-12 |