| NPI | 1275915134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0002739) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 943997) |
| 101YP1600X Counselor, Pastoral (Licence: 11131) | |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2015-06-26 |