| NPI | 1760139638 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6362009401) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6451021910) |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2022-03-09 |