| NPI | 1679256267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-NLEIGK) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA HT723100) |
| 225700000X Massage Therapist (Licence: CA 82448) | |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2024-07-10 |