| NPI | 1750776456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA MC61163620) |
| Additional Taxonomies | 225A00000X Music Therapist |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2021-05-11 |