| NPI | 1073012993 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DE AC-0010445) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2024-09-05 |