| NPI | 1962636712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 600) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TN 457) |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2009-05-07 |