| NPI | 1205556362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA MPSS-QYTVPJ) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA R1476710722) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2024-05-13 |