| NPI | 1285641340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN LPC000282) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN PE000531) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-08 |