| NPI | 1558134585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR QMHA-R-5413) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-4404) |
| 171M00000X Case Manager/Care Coordinator (Licence: OR QMHA-R-5413) | |
| 175T00000X Peer Specialist (Licence: OR 111413) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2024-10-03 |