| NPI | 1013666890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC14418) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: MD ATC367) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2024-10-11 |