| NPI | 1972115640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 11656123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.021763) |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2026-03-27 |