| NPI | 1255782983 |
|---|---|
| Former Name | MYRRA MARIE ALO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 112518) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2023-01-19 |