| NPI | 1194289520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHPC-001294) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 111563) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2026-03-26 |