NPI | 1467047035 |
---|---|
Former Name | RAISA ALISIA MATHIES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904014514) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P014795) |
Enumeration Date | 2021-03-05 |
Last Update Date | 2023-12-18 |