| NPI | 1407062318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN LPC TN005) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN TN MFT002) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |