| NPI | 1720239924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7971518-3501) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: UT 08645) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2013-11-21 |