| NPI | 1275006751 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 61052168) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2021-12-10 |