| NPI | 1255891602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 4549-226) |
| Additional Taxonomies | 221700000X Art Therapist |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2026-03-12 |