| NPI | 1457116535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHP-R-2965) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: T-25-4802) |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2025-11-28 |