| NPI | 1790268928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NY 002198-1) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: NY 002198-1) |
| Enumeration Date | 2018-09-13 |
| Last Update Date | 2020-04-25 |