| NPI | 1770129017 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 097.0134463) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 097.0134463) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2019-11-21 |