| NPI | 1851781363 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 074893) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 0006224) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2024-09-11 |