| NPI | 1033802160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 6410) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 12552) |
| 225A00000X Music Therapist (Licence: 12607) | |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2023-06-02 |