| NPI | 1770606196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149004325) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 149004325) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2025-08-26 |