| NPI | 1386399574 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401224114) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6451022013) |
| Enumeration Date | 2022-02-16 |
| Last Update Date | 2024-04-08 |