| NPI | 1962912287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 11992-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.019738) |
| Enumeration Date | 2017-10-02 |
| Last Update Date | 2026-07-02 |