| NPI | 1073401097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-KXHZLF) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-10-06 |