| NPI | 1356156012 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LGP16155) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LGP16155) |
| 106H00000X Marriage & Family Therapist (Licence: MD LGP16155) | |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-04-10 |