| NPI | 1033748629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.176561) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 374K00000X Religious Nonmedical Practitioner | |
| 101YP1600X Counselor Pastoral | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2021-07-23 |