| NPI | 1427749522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-YAZKGM) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2023-05-20 |