| NPI | 1760257380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.030665) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-20148) |
| Enumeration Date | 2023-11-24 |
| Last Update Date | 2025-12-15 |