| NPI | 1861036113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C013756) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.021245) |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2025-03-28 |