| NPI | 1497603336 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 14740) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 8317) |
| Enumeration Date | 2026-03-17 |
| Last Update Date | 2026-03-17 |