| NPI | 1629770029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225A00000X Music Therapist (Licence: 16657) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: Pre-Licensed) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-03-20 |