| NPI | 1023397486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225800000X Recreation Therapist (Licence: 59165) |
| Additional Taxonomies | 174400000X Specialist |
| 174H00000X Health Educator | |
| 221700000X Art Therapist | |
| 222Q00000X Developmental Therapist | |
| 225600000X Dance Therapist | |
| 225A00000X Music Therapist | |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-08-16 |