| NPI | 1083864359 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 1383) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MT 135) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2024-02-16 |