| NPI | 1790302032 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801110298) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2021-06-22 |