| NPI | 1063202653 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 12959) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC303385) |
| Enumeration Date | 2025-05-08 |
| Last Update Date | 2025-05-08 |