NPI | 1205721339 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHA-R-7209) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 114092) |
Enumeration Date | 2025-06-10 |
Last Update Date | 2025-09-30 |