| NPI | 1407574528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 171M00000X) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2025-06-02 |