| NPI | 1679119952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-ZXJTMA) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2025-08-26 |