| NPI | 1265220248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 221700000X Art Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 172V00000X Community Health Worker (Licence: OR 105615) | |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2026-07-15 |