| NPI | 1992321368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.018893) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.012616) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2020-07-30 |