| NPI | 1144796699 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 256742) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1802969) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2025-02-09 |