| NPI | 1780292425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.020777) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 008398) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2020-07-20 |