| NPI | 1881264497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TN 7230) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2021-06-26 |
| Last Update Date | 2025-11-10 |