| NPI | 1184791162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TN LCPT000035) |
| Additional Taxonomies | 103T00000X Psychologist |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-08 |