| NPI | 1336655711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT 64968) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: 13329) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2024-04-12 |