| NPI | 1063574259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 181) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: TN 4) |
| 106H00000X Marriage & Family Therapist (Licence: TN 90) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2012-09-04 |