| NPI | 1811519630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC017927) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: NY 002463-01) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2025-08-04 |