| NPI | 1982828158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: TN 5504-LCSW) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: TN 5504-LCSW) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2018-10-24 |