| NPI | 1952816258 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2204086-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW127548) |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2024-11-26 |