| NPI | 1508048166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN LPC0000002875) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 3549) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2014-08-04 |