| NPI | 1457942831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-11-10944) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHA-R-6433) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2025-04-21 |