| NPI | 1306514245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHP-R-2358) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 21-QMHA-R-1543) |
| 101YM0800X Counselor, Mental Health (Licence: OR QMHP-R) | |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2023-09-18 |