| NPI | 1699659409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHA-I-004910) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 25-QMHA-I-004910) |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-08-04 |