| NPI | 1780202200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149025242) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 11005123) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2024-01-27 |