| NPI | 1174468698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 141402) |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 175T00000X Peer Specialist (Licence: CA MPSS-CXWGNL) | |
| Enumeration Date | 2026-04-21 |
| Last Update Date | 2026-08-11 |