| NPI | 1073871331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 2865) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 2865) |
| 106H00000X Marriage & Family Therapist (Licence: TN 990) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2022-06-22 |