| NPI | 1366677668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 748) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 2426) |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2021-04-21 |