| NPI | 1043979610 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI 821) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: HI 821) |
| Enumeration Date | 2021-12-10 |
| Last Update Date | 2021-12-15 |