| NPI | 1205932662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 565) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 79330) |
| 101YM0800X Counselor, Mental Health (Licence: TN 1541) | |
| 101YP1600X Counselor, Pastoral (Licence: TN 32) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2011-01-21 |