| NPI | 1922387695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 101064) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2011-08-11 |