| NPI | 1427542166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 221700000X Art Therapist (Licence: 12301) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 3806) |
| Enumeration Date | 2018-06-17 |
| Last Update Date | 2018-06-17 |