| NPI | 1811570591 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801119228) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6851109878) |
| Enumeration Date | 2021-04-30 |
| Last Update Date | 2024-11-22 |