| NPI | 1962027532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 20-QMHA-R-0445) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-21-546) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID L17407) | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2026-02-23 |