| NPI | 1710693544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OR 24-QMHA-R6242) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-4760) |
| 175T00000X Peer Specialist (Licence: OR 000106008) | |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2025-02-10 |