| NPI | 1003372616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-DEROMN) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 172V00000X Community Health Worker | |
| 247200000X Technician, Other | |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2025-02-25 |