| NPI | 1689089963 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1723) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 1695) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2018-04-09 |