| NPI | 1376313262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHP-R-3227) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-4472) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2024-01-03 |
| Last Update Date | 2025-04-08 |