| NPI | 1558752717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHPC-00713) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 14-03-27) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2026-03-20 |