| NPI | 1790251759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.103372) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2022-10-27 |