| NPI | 1780102848 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6361007739) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401018548) |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2024-07-24 |