| NPI | 1023973153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-BDIMLW) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA MPSS-BDIMLW) |
| Enumeration Date | 2025-12-20 |
| Last Update Date | 2025-12-29 |