| NPI | 1942886049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.030143) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: IL 150.110071) | |
| Enumeration Date | 2021-03-20 |
| Last Update Date | 2025-09-26 |