| NPI | 1477272847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA R1563750624) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-PDNXEL) |
| Enumeration Date | 2022-08-26 |
| Last Update Date | 2024-09-12 |