| NPI | 1578254124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA HRPSS011671) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2025-12-12 |