| NPI | 1457979239 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851110812) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2022-01-31 |