NPI | 1972115640 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.021763) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 11656123) |
Enumeration Date | 2020-08-23 |
Last Update Date | 2025-09-11 |