| NPI | 1649860115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-EQTMLB) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2025-08-25 |