| NPI | 1144050840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-GOVXRA) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2024-12-16 |