| NPI | 1376294728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MI 4703129876) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2024-08-02 |