| NPI | 1033708557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61491880) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: NY 002119) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2023-11-09 |