| NPI | 1093918385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN LPC0000003565) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 0485) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2018-02-09 |