| NPI | 1740825124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR 19-QMHA-R-0074) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-R-0074) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-11-09 |
| Last Update Date | 2026-08-27 |