| NPI | 1598520512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PA PC016753) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: PA 15285) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-02-19 |