| NPI | 1558463786 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 541-124) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 541-124) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2025-02-12 |