NPI | 1922211887 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN PE0000000693) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TN 0000000016) |
101YP2500X Counselor, Professional (Licence: VA 0701000462) | |
106H00000X Marriage & Family Therapist (Licence: TN 0000000011) | |
Enumeration Date | 2007-05-08 |
Last Update Date | 2007-07-08 |