| NPI | 1255100988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-I-01568) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 24-11-11301) |
| Enumeration Date | 2023-12-21 |
| Last Update Date | 2025-09-04 |