| NPI | 1730498346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WY LPC-1664) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0012361) |
| 225600000X Dance Therapist (Licence: NY 001383-1) | |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2019-03-13 |