| NPI | 1972140648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.024821) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: IL 2442650) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2025-04-03 |