| NPI | 1861818577 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6351001807) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401014153) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2025-02-08 |