| NPI | 1134721590 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401019232) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH RBT-19-97014) |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2021-05-20 |