| NPI | 1467733618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 225A00000X Music Therapist (Licence: MI 10003) | |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2020-02-13 |