| NPI | 1427265719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 0888) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: KY 05-029) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2007-07-08 |