| NPI | 1578340733 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801117483) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 127371) |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2024-09-08 |