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 |