| NPI | 1023669827 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 61639481) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 128582) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2025-08-12 |