| NPI | 1609210624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN MD4071) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TN MD4071) |
| Enumeration Date | 2013-04-21 |
| Last Update Date | 2013-04-21 |