| NPI | 1811683980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR 23-QMHA-I-003923) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHA-I-003923) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2026-09-28 |