NPI | 1467595819 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 933439) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OH 3237) |
Enumeration Date | 2007-02-15 |
Last Update Date | 2007-07-08 |