| NPI | 1700518537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-GTPQYZ) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-08-22 |