| NPI | 1538589890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 221700000X Art Therapist (Licence: NY 002297) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2022-01-26 |