| NPI | 1952080988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149028901) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150110853) |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-05-22 |