| NPI | 1629133004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TN LPC0000000289) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TN PE0000011753) |
| 106H00000X Marriage & Family Therapist (Licence: TN LMT0000000027) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2024-06-10 |