| NPI | 1538872304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: NJ 17199) |
| Enumeration Date | 2022-12-27 |
| Last Update Date | 2024-03-27 |