| NPI | 1174299291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHA-I-004128) |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator (Licence: OR 24-QMHA-I-004128) | |
| 175T00000X Peer Specialist (Licence: OR 112437) | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2024-12-06 |