| NPI | 1164079364 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801107097) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2020-12-09 |