| NPI | 1669918504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 13679) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 4029) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-01-17 |