| NPI | 1003922311 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH 19835) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149012618) |
| 1041C0700X Social Worker, Clinical (Licence: CT 000465) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2010-04-08 |