| NPI | 1881568715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: IL 178.021187) |
| Additional Taxonomies | 221700000X Art Therapist (Licence: 24-718) |
| Enumeration Date | 2025-10-02 |
| Last Update Date | 2025-10-02 |