| NPI | 1760033658 |
|---|---|
| Former Name | SANDRA LARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401017655) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401223151) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2026-04-14 |