| NPI | 1235233933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 420) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN LSPE137) |
| 106H00000X Marriage & Family Therapist (Licence: TN LMFT163) | |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2019-10-11 |