| NPI | 1386624336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN LPC0000000674) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: TN LCPT0000000028) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2007-07-08 |