| NPI | 1104440445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR 19-QMHA-I-02746) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-I-02746) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2026-08-26 |