| NPI | 1154040798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHA-R-6626) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000106875) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2025-02-21 |