| NPI | 1255156907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-QRYLMA) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NA) |
| 172V00000X Community Health Worker | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2025-08-12 |