| NPI | 1902251333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHP-R-2718) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2025-12-16 |