| NPI | 1477887701 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904007682) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2023-04-17 |