| NPI | 1548649452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 21-QMHP-R-0771) |
| 225A00000X Music Therapist (Licence: OR 10186042) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2022-05-26 |