| NPI | 1871262824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: IL 149023231) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 149023231) |
| Enumeration Date | 2021-09-12 |
| Last Update Date | 2024-05-17 |