| NPI | 1063138121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CO LPCC.0019421) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: CO 22-477) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2022-11-16 |