| NPI | 1558117564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist (Licence: CA MPSS-VCJLOZ) | |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2026-02-24 |