| NPI | 1578118428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6851115390) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 247200000X | |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2022-07-22 |