| NPI | 1134861214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 78243) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: 07339) |
| Enumeration Date | 2022-04-10 |
| Last Update Date | 2022-04-10 |