| NPI | 1740541853 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2007000451) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149015505) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2014-03-04 |