| 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 |