NPI | 1114074697 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 892596) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E0003810) |
Enumeration Date | 2007-01-05 |
Last Update Date | 2007-07-08 |