| NPI | 1972661015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TN 171) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN 196) |
| 106H00000X Marriage & Family Therapist (Licence: TN 48) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |