| NPI | 1972907004 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.013064) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60489965) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2024-05-28 |