| NPI | 1043033236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHA-R-2796) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000106413) |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2024-11-07 |