| NPI | 1649505918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN LPC0000001782) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM LMHC0060661) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2009-10-05 |