| NPI | 1558400473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TN LDC273) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TN LPC747) |
| 106H00000X Marriage & Family Therapist (Licence: TN LMT562) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |