| 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 |