| NPI | 1023339025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA MPSS-XVG4DX) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2025-04-30 |