| NPI | 1871319509 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc04038) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 11283-125) |
| Enumeration Date | 2024-11-26 |
| Last Update Date | 2024-11-26 |