| NPI | 1407109408 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60887254) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WA LW60887254) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2022-03-10 |