| NPI | 1932732435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN LDC1143) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 101Y00000X Counselor | |
| Enumeration Date | 2020-02-13 |
| Last Update Date | 2020-02-13 |