| NPI | 1811102601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH16746) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701001421) |
| 106H00000X Marriage & Family Therapist (Licence: TN MFT158) | |
| 106H00000X Marriage & Family Therapist (Licence: TN MFT 158) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2024-03-15 |