| NPI | 1194802488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 933699) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: OH Ordained Minister) |
| 101YP2500X Counselor, Professional (Licence: OH E-0001964) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |