| NPI | 1558117564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 372600000X Adult Companion | |
| 175T00000X Peer Specialist (Licence: CA MPSS-VCJLOZ) | |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2025-09-15 |