| NPI | 1558144915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6451024458) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 156140) |
| 225A00000X Music Therapist (Licence: 13115) | |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2025-08-15 |