| NPI | 1992333959 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC12338) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP10262) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2022-10-27 |