| NPI | 1396870556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-LDEZIM) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2026-08-11 |