| NPI | 1124855507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-PVHWXT) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2025-08-14 |