| NPI | 1346881281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 008326) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: NY 002175) |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-10-02 |