| NPI | 1407987761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 221700000X Art Therapist (Licence: KY 114134) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 136) |
| 221700000X Art Therapist (Licence: KY 0136) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2016-06-02 |