| NPI | 1316678659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-CYUFDS) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2025-08-12 |