| NPI | 1326755968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 221700000X Art Therapist (Licence: CO LPCC.0019213) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0019213) |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2022-11-02 |