| NPI | 1912936261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 054) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TN 0054) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2009-08-05 |