| NPI | 1790988301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2004019050) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2007013688) |
| 101YP2500X Counselor, Professional (Licence: TN 1988) | |
| 106H00000X Marriage & Family Therapist (Licence: TN 599) | |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2009-03-01 |