| NPI | 1740728401 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 1-17-26744) |
| Additional Taxonomies | 225800000X Recreation Therapist (Licence: MI 61754) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-08-16 |