| NPI | 1982173589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 26-QMHP-R-4321) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 18-01-43) |
| 171M00000X Case Manager/Care Coordinator (Licence: OR 21-QMHA-II-000009) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2026-06-25 |