| NPI | 1790247757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 10072-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 22128) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149020671) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-04-23 |