| NPI | 1205490596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MI Q004955) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2021-07-27 |