| NPI | 1265688477 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA LICSW126031) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34004826A) |
| 1041C0700X Social Worker, Clinical (Licence: VT 089.0119140) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2024-06-06 |