| NPI | 1902381429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC011808) |
| Additional Taxonomies | 225A00000X Music Therapist (Licence: 09838) |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2019-10-01 |