| NPI | 1013571967 |
|---|---|
| Former Name | JUSTINE DIETZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2021015988) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IN 33009200A) |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2025-01-30 |