| NPI | 1043752728 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121740) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 221989) |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2024-12-11 |