| NPI | 1700979192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TN 344) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TN 344) |
| 101YM0800X Counselor Mental Health (Licence: TN 344) | |
| 101YP2500X Counselor Professional (Licence: TN 344) | |
| 103TC0700X Psychologist Clinical (Licence: TN 870) | |
| 106H00000X Marriage & Family Therapist (Licence: TN 128) | |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2007-07-08 |