| NPI | 1063067619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851115372) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2022-08-08 |