| NPI | 1821601519 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC14698) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2025-01-16 |