| NPI | 1407126469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-IUXREV) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: CA MPSSIUXREV) |
| 372600000X Adult Companion (Licence: CA MPSS-IUXREV) | |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2025-05-21 |