| NPI | 1598767444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN TN8547) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN TN8547) |
| 101YM0800X Counselor, Mental Health (Licence: TN TN8547) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: TN TN8547) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2010-10-19 |