| NPI | 1053013482 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MN CC03439) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2024-06-27 |