| NPI | 1871218057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC018375) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: PA 17450) |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2025-04-06 |