| NPI | 1598930885 |
|---|---|
| Former Name | DIANA JEAN ROTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 007078) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 007078) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2011-02-28 |