| NPI | 1174012389 |
|---|---|
| Former Name | JATAYVIA JAQAE WALLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851115529) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2023-04-08 |