| NPI | 1497729701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN LPC422) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN PE1317) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2007-07-08 |