| NPI | 1912443482 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401223373) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.011626) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2024-08-07 |