| NPI | 1952049884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.027119) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: IL 150.110743) |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2026-01-12 |