| NPI | 1265108484 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 25126) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L14321) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2024-05-08 |