| NPI | 1962016071 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NY F402984) |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2024-11-01 |