| NPI | 1194610766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-23-2748) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHA-R-7103) |
| Enumeration Date | 2025-06-12 |
| Last Update Date | 2025-06-12 |