| NPI | 1174036719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 4580) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MA 11900-MT-MT) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2021-07-01 |