| NPI | 1679128995 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0016756) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 0016638) |
| Enumeration Date | 2019-08-04 |
| Last Update Date | 2023-01-05 |