| NPI | 1669778122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: KY 1243) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 1243) |
| 221700000X Art Therapist | |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2022-05-19 |