| NPI | 1588742837 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MN 16855) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 54520) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-09-09 |