| NPI | 1073660650 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1983) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 1138) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2007-07-09 |