| NPI | 1457831505 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: KY 243209) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: KY 174863) |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |