| NPI | 1922851583 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: MA LMHC10001841) |
| Additional Taxonomies | 225600000X Dance Therapist (Licence: MA LMHC10001841) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2024-04-14 |