| NPI | 1225640204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10001098) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: 21-446) |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2023-09-21 |