| NPI | 1891145785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149022464) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 8910-123) |
| 104100000X Social Worker (Licence: WI 130043-121) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2020-08-27 |