| NPI | 1588154447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC-19262) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: AZ LPC-19262) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2020-09-28 |