| NPI | 1184466013 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-VFPKWU) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-06-11 |
| Last Update Date | 2025-05-12 |