| NPI | 1407576028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 175T00000X Peer Specialist (Licence: CA MPSS-USVCEY) | |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2024-04-02 |