| NPI | 1366911968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 372600000X Adult Companion |
| 175T00000X Peer Specialist (Licence: CA MPSS-KRGEQH) | |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2026-03-25 |