| NPI | 1891376646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.026910) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.105296) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2024-04-04 |