| NPI | 1619625910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-23-2550) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHA-I-003642) |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2024-03-14 |