| NPI | 1073893145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MN cc01349) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: NY 001237) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2023-10-09 |