| NPI | 1679316061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-ITLASJ) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-10-28 |