| NPI | 1376165035 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 111259) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MD 21993) |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2024-09-17 |