| NPI | 1982328290 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 0017911) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 002302-01) |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2023-01-13 |