| NPI | 1902312937 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801106334) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2020-02-10 |