| NPI | 1275526436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN LSW0000001208) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TN LPC0000000394) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2015-03-24 |