| NPI | 1265884019 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801116976) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NJ A58664067159892) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2024-05-05 |