| NPI | 1386477230 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.027579) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0136253TELE) |
| Enumeration Date | 2024-08-24 |
| Last Update Date | 2024-12-02 |