| NPI | 1720802291 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 11562-125) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 7526-226) |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2025-02-05 |