| NPI | 1720862089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-KQHMIJ) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2024-03-19 |