| 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 |