| NPI | 1285985085 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 20318) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801095470) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2024-05-28 |