| NPI | 1346415254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN LPC0000001652) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701003303) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2008-04-23 |