| NPI | 1689864126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180 003396) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN LPC 365) |
| 103TS0200X Psychologist, School (Licence: 10580) | |
| 103TS0200X Psychologist, School (Licence: IL 969747) | |
| 103TS0200X Psychologist, School (Licence: 1233025) | |
| 106H00000X Marriage & Family Therapist (Licence: TN LMT 145) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2007-07-31 |