| NPI | 1700804283 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO SW000967) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.022665) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2022-11-17 |