| NPI | 1942957493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149029299) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150.106636) |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2025-06-04 |