| NPI | 1821629239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC011367) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 12442) |
| 221700000X Art Therapist (Licence: 18-018) | |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2021-11-10 |