| NPI | 1457600074 |
|---|---|
| Former Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-NOJFUP) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA IMF69928) |
| 101YM0800X Counselor, Mental Health | |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2025-03-13 |