| NPI | 1578091997 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 124029) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW95805) |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2024-07-16 |