| NPI | 1861860959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149024295) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW06399) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2024-05-06 |