| NPI | 1104366129 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 111634) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MA 111634) |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2021-04-08 |