| NPI | 1295600849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-SWAGIC) |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2026-05-26 |