| NPI | 1639010101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-WMGELR) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2026-04-01 |
| Last Update Date | 2026-04-02 |