| NPI | 1508387747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 19-QMHA-I-02381) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2025-04-18 |