| NPI | 1588833479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: TN PE0000001755) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TN LPC0000000416) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2008-02-25 |