| NPI | 1649866898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC016160) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: 15938) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2023-09-21 |