| NPI | 1235628199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0015836) |
| 225A00000X Music Therapist (Licence: CO 13551) | |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2024-04-02 |