| NPI | 1740751619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHP-R-R-1727) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1325701018) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2023-02-06 |