| NPI | 1316477441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR THW0002219) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR 19-QMHPC-00380) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2019-05-24 |