| NPI | 1699418848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OR 23-QMHA-1-004015) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 23-QMHA-R-3380) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2022-04-15 |
| Last Update Date | 2023-10-24 |