| NPI | 1639185523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KY KY-0132) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN LPC000029) |
| 106H00000X Marriage & Family Therapist (Licence: TN LMT00000094) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2013-08-26 |