| NPI | 1922734607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149029106) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.107425) |
| Enumeration Date | 2022-07-26 |
| Last Update Date | 2025-04-15 |