| NPI | 1780177998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149.022259) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.103114) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2023-03-16 |