NPI | 1275120206 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020635) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM CTB-2022-0960) |
221700000X Art Therapist (Licence: 22-192) | |
Enumeration Date | 2020-12-23 |
Last Update Date | 2024-05-21 |