| NPI | 1376364075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-LVMKTC) |
| Enumeration Date | 2024-10-24 |
| Last Update Date | 2025-04-08 |