| NPI | 1871269803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701010671) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 221700000X Art Therapist | |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2022-03-01 |