| NPI | 1699487413 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 1107125) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 7045226) |
| Enumeration Date | 2022-12-23 |
| Last Update Date | 2024-06-05 |