| NPI | 1407672603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-DTARZX) |
| Enumeration Date | 2024-12-03 |
| Last Update Date | 2026-04-08 |