| NPI | 1619849056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH27789) |
| Additional Taxonomies | 104100000X Social Worker |
| 221700000X Art Therapist (Licence: FL MH27789) | |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2026-06-03 |