| NPI | 1902525405 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2000175108) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 2109) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2022-08-26 |