| NPI | 1215505953 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LGP11817) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MD RBT-21-171569) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2021-10-08 |