| NPI | 1861581167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN LPC0000000108) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN LMT0000000058) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |