| NPI | 1790362879 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MI 4703123770) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2024-11-19 |