| NPI | 1053131805 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 19716) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW128345) |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2024-10-16 |