NPI | 1972681310 |
---|---|
Former Name | ANGELA MARIE CANUP |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301012672) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MI 6301012672) |
Enumeration Date | 2006-11-02 |
Last Update Date | 2013-07-15 |