| NPI | 1114240991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPPS-AXUHFQ) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2024-03-13 |