| NPI | 1376166876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHA-R-4616) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-12-10) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2023-11-29 |