| NPI | 1811261191 |
|---|---|
| Former Name | TATIANA INDRISEK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-19413) |
| Additional Taxonomies | 174N00000X Lactation Consultant, Non-RN (Licence: AZ L-21963) |
| Enumeration Date | 2012-03-03 |
| Last Update Date | 2021-08-31 |