| NPI | 1396576633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-XFOVNQ) |
| Additional Taxonomies | 101Y00000X Counselor |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2025-04-02 |