| NPI | 1952761421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.021206) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150101587) |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2019-05-08 |