| NPI | 1083758692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 923214) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral (Licence: 3423) |
| 101YP2500X Counselor Professional (Licence: OH E0003157) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2007-07-09 |