| NPI | 1669944393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 07547) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: 13182) |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2025-09-02 |