| NPI | 1710855408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHA-R-6784) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-25-5154) |
| Enumeration Date | 2025-10-25 |
| Last Update Date | 2025-10-25 |