| NPI | 1295785962 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 53631223501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-17679) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-02-28 |