| NPI | 1104930734 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I-06827) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM M-4311) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-09-04 |