| NPI | 1164286647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 172V00000X) |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist (Licence: CA 373H00000X) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-05-14 |