| NPI | 1164463766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN LPC1910) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 169249) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2019-06-17 |