| NPI | 1457895922 |
|---|---|
| Former Name | BAYLIE M SURJONO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 112307) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0002217) |
| Enumeration Date | 2016-12-18 |
| Last Update Date | 2024-03-06 |