| NPI | 1225775331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA MPSS-HFOMJS) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 175T00000X Peer Specialist (Licence: CA MPSS-HFOMJS) | |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2024-01-11 |