| NPI | 1487709853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 0000002026) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN PE0000011660) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2007-07-08 |