| NPI | 1326313669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA LQCMPFRZXEBGYUAN) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2023-09-15 |