| NPI | 1548200322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN LPC0000001693) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN LMT0000000581) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2008-09-29 |