| NPI | 1790240513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149-022061) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 150-103309) |
| Enumeration Date | 2019-02-06 |
| Last Update Date | 2022-05-28 |