| NPI | 1770189979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 221700000X Art Therapist (Licence: NY 002955) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2024-01-30 |