| NPI | 1003274499 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 08777) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR P1404042) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2019-01-03 |