| NPI | 1881478550 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 6055) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 005475) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2023-08-23 |