| 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 |