| NPI | 1891595963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-25-6024) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 113517) |
| 101YM0800X Counselor, Mental Health (Licence: OR 25-PILOT-0025) | |
| Enumeration Date | 2025-03-17 |
| Last Update Date | 2025-10-27 |