| NPI | 1205560786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA MPSS-FWMJPU) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist (Licence: CA MPSS-FWMJPU) | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2025-06-16 |