| NPI | 1922370493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN 0000001537) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TN 0000001537) |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2012-02-01 |