| NPI | 1619135704 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017167) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI MI-6301012146) |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2020-10-21 |